Digital Imaging and Communications in Medicine (DICOM) Supplement 119: Frame Level Retrieve SOP Classes

Page i 5 Digital Imaging and Communications in Medicine (DICOM) Supplement 119: Frame Level Retrieve SOP Classes 10 15 20 Prepared by: Working Group 6 DICOM Standards Committee, Working Group 6 1300 N. 17th Street, Suite 1752 Rosslyn, Virginia 22209 USA 25 VERSION: Final Text, 20 Jan 2009 Developed pursuant to DICOM Work Item 2005-12-A

Page 2 Table of Contents 30 35 40 45 50 55 60 65 70 Table of Contents... 2 Scope & Field of Application... 6 Changes to NEMA Standards Publication PS 3.2-2008... 7 Changes to NEMA Standards Publication PS 3.3-2008... 8 Changes to NEMA Standards Publication PS 3.4-2008... 10 Annex X Instance and Frame Level Retrieve SOP Classes (Normative)... 10 X.1 Overview... 10 X.1.1 Scope... 10 X.1.2 Composite Instance Root Retrieve Information Model... 10 X.1.3 Service Definition... 10 X.2 Composite Instance Root Retrieve Information Model definition... 11 X.2.1 Entity-Relationship Model Definition... 12 X.2.2 Attributes Definition... 12 X.3 Standard Composite Instance Root Retrieve Information Model... 12 X.3.1 Composite Instance Root Information Model... 12 X.3.2 Construction and Interpretation of Frame Range Keys... 12 X.3.2.1 Frame List Definitions... 12 X.3.2.1.1 Simple Frame List... 12 X.3.2.1.2 Calculated Frame List... 13 X.3.2.1.3 Time Range... 13 X.3.3 New Object Creation at the FRAME level... 14 X.4 DIMSE-C service groups... 15 X.4.1 C-MOVE Operation... 15 X.4.1.1 C-MOVE Service Parameters... 15 X.4.1.1.1 SOP Class UID... 15 X.4.1.1.2 Priority... 16 X.4.1.1.3 Identifier... 16 X.4.1.1.3.1 Request Identifier Structure... 16 X.4.1.1.4 Status... 16 X.4.1.1.5 Number of Remaining Sub-Operations... 17 X.4.1.1.6 Number of Completed Sub-Operations... 17 X.4.1.1.7 Number of Failed Sub-Operations... 17 X.4.1.1.8 Number of Warning Sub-Operations... 17 X.4.1.2 C-MOVE SCU Behavior... 17 X.4.1.3 C-MOVE SCP Behavior... 18 X.4.2 C-GET Operation... 19 X.4.2.1 C-GET Service Parameters... 19 X.4.2.1.1 SOP Class UID... 19 X.4.2.1.2 Priority... 19 X.4.2.1.3 Identifier... 20 X.4.2.1.3.1 Request Identifier Structure... 20 X.4.2.1.4 Status... 20 X.4.2.1.5 Number of Remaining Sub-Operations... 21

Page 3 75 80 85 90 95 100 105 110 115 X.4.2.1.6 Number of Completed Sub-Operations... 21 X.4.2.1.7 Number of Failed Sub-Operations... 21 X.4.2.1.8 Number of Warning Sub-Operations... 21 X.4.2.2 C-GET SCU Behavior... 21 X.4.2.3 C-GET SCP Behavior... 22 X.5 Association negotiation... 23 X.5.1 Association Negotiation for C-GET SOP Classes... 23 X.6 SOP Class Definitions... 23 X.6.1 Composite Instance Root SOP Class Group... 23 X.6.1.1 Composite Instance Root Retrieve Only Information Model... 24 X.6.1.1.1 E/R Model... 24 X.6.1.1.2 Composite Instance Level... 24 X.6.1.1.3 Frame Level... 24 X.6.1.1.4 Scope of the C-MOVE or C-GET Commands and Sub-Operations 25 X.6.1.2 Conformance Requirements... 25 X.6.1.2.1 SCU Conformance... 25 X.6.1.2.1.1 C-MOVE SCU Conformance... 25 X.6.1.2.1.2 C-GET SCU Conformance... 25 X.6.1.2.2 SCP Conformance... 25 X.6.1.2.2.1 C-MOVE SCP Conformance... 26 X.6.1.2.2.2 C-GET SCP Conformance... 26 X.6.1.3 SOP Classes... 26 Annex Y Composite Instance Retrieve Without Bulk Data SOP Classes (Normative)... 27 Y.1 Overview... 27 Y.1.1 Scope... 27 Y.1.2 Composite Instance Retrieve Without Bulk Data Information Model... 27 Y.1.3 Attributes Not Included... 27 Y.1.4 Service Definition... 27 Y.2 Composite Instance Retrieve Without Bulk Data Information Model definition... 28 Y.2.1 Y.2.2 Entity-Relationship Model Definition... 29 Attributes Definition... 29 Y.3 Standard Composite Instance Retrieve Without Bulk Data Information Model... 29 Y.3.1 Composite Instance Retrieve Without Bulk Data Information Model... 29 Y.4 DIMSE-C service groups... 29 Y.4.1 C-GET Operation... 29 Y.4.2.1 C-GET Service Parameters... 30 Y.4.2.1.1 SOP Class UID... 30 Y.4.2.1.2 Priority... 30 Y.4.2.1.3 Identifier... 30 Y.4.2.1.3.1 Request Identifier Structure... 30 Y.4.2.1.4 Status... 30 Y.4.2.1.5 Number of Remaining Sub-Operations... 31 Y.4.2.1.6 Number of Completed Sub-Operations... 31 Y.4.2.1.7 Number of Failed Sub-Operations... 31 Y.4.2.1.8 Number of Warning Sub-Operations... 31 Y.4.2.2 C-GET SCU and C-STORE SCP Behavior... 31 Y.4.2.3 C-GET SCP and C-STORE SCU Behavior... 32

Page 4 120 125 130 135 140 145 150 155 160 Y.5 Association negotiation... 33 Y.5.1 Association Negotiation for C-GET SOP Classes... 33 Y.6 SOP Class Definitions... 33 Y.6.1 Composite Instance Retrieve Without Bulk Data SOP Class Group... 33 Y.6.1.1 Composite Instance Retrieve Without Bulk Data Information Model... 34 Y.6.1.1.1 E/R Model... 34 Y.6.1.1.2 Composite Instance Level... 34 Y.6.1.1.3 Scope of the C-GET Commands and Sub-Operations... 34 Y.6.1.2 Conformance Requirements... 34 Y.6.1.2.1 SCU Conformance... 34 Y.6.1.2.2 SCP Conformance... 35 Y.6.1.3 SOP Classes... 35 Changes to NEMA Standards Publication PS 3.6-2008... 36 Changes to NEMA Standards Publication PS 3.6-2008... 36 Changes to NEMA Standards Publication PS 3.16-2008... 37 Changes to NEMA Standards Publication PS 3.17-2008... 38 Annex ZX Use Cases for the Composite Instance Root Retrieval Classes... 38 ZX.1 Clinical Review... 38 ZX.1.1 Retrieval based on report references... 38 ZX.1.2 Selective retrieval without references to specific slices... 38 ZX.2 Local use relevant priors... 38 ZX.2.1 Anatomic sub-region... 38 ZX.2.2 Worklists... 39 ZX.3 Attribute based retrieval... 39 ZX.4 CAD & data mining Applications... 39 ZX.5 Independent WADO Server... 39 Annex ZY Example SCU use of the Composite Instance Root Retrieval Classes... 39 ZY.1 Retrieval of entire Composite instances... 39 ZY.2 Retrieval of SELECTED FRAME Composite instances from multi-frame objects... 39 ZY.3 Retrieval of SELECTED FRAME Composite instances from MPEG-2 Video... 39 Annex ZZ Considerations for Applications Creating New Images from Multi-Frame Images... 41 ZZ.1 Scope... 41 ZZ.2 FRAME EXTRACTION Issues... 41 ZZ.2.1 Number of Frames... 41 ZZ.2.2 Start and End Times... 41 ZZ.2.3 Time Interval vs. Frame Increment Vector... 41 ZZ.2.4 MPEG-2... 41 ZZ.2.5 JPEG 2000 Part 2 Multi-Component Transform... 42 ZZ.2.6 Functional Groups for enhanced CT, MR etc.... 42 ZZ.2.7 Nuclear Medicine Images... 42 ZZ.2.8 A Single-Frame Multi-Frame Image... 42 ZZ.3 Frame Numbers... 42 ZZ.4 Consistency... 42 ZZ.5 Time Synchronization... 42 ZZ.6 Audio... 43

Page 5 165 ZZ.7 Private attributes... 43

Page 6 Scope & Field of Application This Supplement describes extensions to the existing Query/Retrieve Service Class to support retrieval of: individual frames and ranges of frames from multi-frame image objects. 170 an extract of any composite storage instance without the pixel data or other bulk attributes. composite instances based only on their SOP Instance UID without requiring knowledge of the Study and Series Instance UIDs. With the introduction of potentially very large multi-frame objects such as enhanced CT & MR there is a need to selectively extract referenced frames without having to retrieve the entire large object. 175 The retrieval of instances with selected frames is implemented using the C-GET and C-MOVE operations. The SOP instances sent are complete and valid, and therefore usable by both the requester and other C- MOVE recipients The retrieval of instances without bulk data is implemented using only the C-GET operation since: the use cases all require the data to be sent to the originator of the request 180 the data sent is not a complete valid SOP instance, and should not be sent using a standard C- STORE operation.

Page 7 Changes to NEMA Standards Publication PS 3.2-2008 185 Digital Imaging and Communications in Medicine (DICOM) Part 2: Information Object Definitions Add SOP Class to PS 3.2 Table A.1-2 UID VALUES 190 Table A.1-2 UID Value UID NAME Category 1.2.840.10008.5.1.4.1.2.4.2 Composite Instance Root Retrieve MOVE 1.2.840.10008.5.1.4.1.2.4.3 Composite Instance Root Retrieve GET 1.2.840.10008.5.1.4.1.2.5.3 Composite Instance Retrieve Without Bulk Data GET Query/Retrieve Query/Retrieve Query/Retrieve

Page 8 Changes to NEMA Standards Publication PS 3.3-2008 Digital Imaging and Communications in Medicine (DICOM) Part 3: Information Object Definitions

Page 9 195 PS 3.3 Add new Table C.12-x in New Section C.12.3 EDITORIAL NOTE: This module needs to be added to ALL multi-frame IODs as conditional, Required if the SOP Instance was created in response to a Frame-Level retrieve request. Table C.12-x FRAME EXTRACTION MODULE ATTRIBUTES Attribute Name Tag Type Attribute Description Frame Extraction Sequence (0008,1164) 1 Sequence containing details of how this SOP Instance was extracted from a source multi-frame SOP Instance. >Multi-Frame Source SOP Instance UID If this instance was created from an instance that contains a Frame Extraction Sequence, then this sequence shall contain all of the items from the parent s Frame Extraction Sequence and a new item that describes this extraction. One or more items shall be present. (0008,1167) 1 SOP Instance from which the frames of this instance are extracted. >Simple Frame List (0008,1161) 1C A list of Frames that were extracted in the form of a simple list. Required if object extraction is based on a Frame Level Retrieve using the Simple Frame List (0008,1161) attribute. See PS3.4 "Instance and Frame Level Retrieve SOP Classes" >Calculated Frame List (0008,1162) 1C A list of Frames that were extracted in the form of one or more triplets Required if object extraction is based on a Frame Level Retrieve using the Calculated Frame List (0008,1162) attribute. See PS3.4 "Instance and Frame Level Retrieve SOP Classes" >Time Range (0008,1163) 1C The start and end times of the frames that were extracted. Required if object extraction is based on a Frame Level Retrieve using the Time Range (0008,1163) attribute. See PS3.4 "Instance and Frame Level Retrieve SOP Classes"

Page 10 200 Changes to NEMA Standards Publication PS 3.4-2008 Digital Imaging and Communications in Medicine (DICOM) PS 3.4 Insert New Annex X as follows Part 4: Service Class Specifications 205 Annex X Instance and Frame Level Retrieve SOP Classes (Normative) X.1 OVERVIEW 210 215 220 X.1.1 Scope Composite Instance Root Retrieve Service is a service within the DICOM Query/Retrieve Service class defined in Annex C. The retrieve capability of this service allows a DICOM AE to retrieve Composite Instances or selected frames from a remote DICOM AE over a single Association or request the remote DICOM AE to initiate a transfer of Composite Object Instances or selected frames from image objects to another DICOM AE. X.1.2 Composite Instance Root Retrieve Information Model Retrievals are implemented against the Composite Instance Root Retrieve Information Model, as defined in this Annex of the DICOM Standard. A specific SOP Class of the Query/Retrieve Service Class consists of an Information Model Definition and a DIMSE-C Service Group. X.1.3 Service Definition Two peer DICOM AEs implement a SOP Class of the Composite Instance Root Retrieve Service with one serving in the SCU role and one serving in the SCP role. SOP Classes of the Composite Instance Root Retrieve Service are implemented using the DIMSE-C C-MOVE and C-GET services as defined in PS 3.7. The following descriptions of the DIMSE-C C-GET and C-MOVE services provide a brief overview of the SCU/SCP semantics: a) A C-MOVE service conveys the following semantics: 225 230 The SCU supplies Unique and Frame Range Key values to identify the requested SOP Instance(s). The SCP creates new SOP instances if necessary and then initiates C-STORE sub-operations for the corresponding storage SOP Instances. These C-STORE suboperations occur on a different Association than the C-MOVE service. The SCP role of the Retrieve SOP Class and the SCU role of the Storage SOP Class may be performed by different applications that may or may not reside on the same system. Initiation mechanism of C-STORE sub-operations is outside of the scope of DICOM standard.

Page 11 235 240 245 250 255 260 265 The SCP may optionally generate responses to the C-MOVE with status equal to Pending during the processing of the C-STORE sub-operations. These C-MOVE responses indicate the number of Remaining C-STORE sub-operations and the number of C-STORE suboperations returning the status of Success, Warning, and Failed. When the number of Remaining C-STORE sub-operations reaches zero, the SCP generates a final response with a status equal to Success, Warning, Failed, or Refused. This response shall indicate the number of C-STORE sub-operations returning the status of Success, Warning, and Failed. If any of the sub-operations was successful then a Successful UID list shall be returned. If the status of a C-STORE sub-operation was Failed a UID List shall be returned. The SCU may cancel the C-MOVE service by issuing a C-MOVE-CANCEL request at any time during the processing of the C-MOVE. The SCP terminates all incomplete C-STORE suboperations and returns a status of Canceled. b) A C-GET service conveys the following semantics: The SCU supplies Unique and Frame Range Key values to identify the requested SOP Instance(s). The SCP creates new SOP instances if necessary and then generates C-STORE sub-operations for the corresponding storage SOP Instances. These C-STORE suboperations occur on the same Association as the C-GET service and the SCU/SCP roles are reversed for the C-STORE. The SCP may optionally generate responses to the C-GET with status equal to Pending during the processing of the C-STORE sub-operations. These C-GET responses indicate the number of remaining C-STORE sub-operations and the number of C-STORE sub-operations returning the status of Success, Warning, and Failed. When the number of Remaining C-STORE sub-operations reaches zero, the SCP generates a final response with a status equal to Success, Warning, Failed, or Refused. This response shall indicate the number of C-STORE sub-operations returning the status of Success, Warning, and Failed. If the status of any C-STORE sub-operation was Failed a UID List shall be returned. The SCU may cancel the C-GET service by issuing a C-GET-CANCEL request at any time during the processing of the C-GET. The SCP terminates all incomplete C-STORE suboperations and returns a status of Canceled. X.2 COMPOSITE INSTANCE ROOT RETRIEVE INFORMATION MODEL DEFINITION The Composite Instance Root Retrieve Information Model is identified by the SOP Class negotiated at Association establishment time. The SOP Class is composed of both an Information Model and a DIMSE- C Service Group. 270 Note: This SOP Class identifies the class of the Composite Instance Root Retrieve Information Model (i.e. not the SOP Class of the stored SOP Instances for which the SCP has information) Information Model Definitions for standard SOP Classes of the Composite Instance Root Retrieve Service are defined in this Annex. A Composite Instance Root Retrieve Information Model Definition contains: 275 Entity-Relationship Model Definition Key Attributes Definition

Page 12 280 X.2.1 Entity-Relationship Model Definition For any Composite Instance Root Retrieve Information Model, an Entity-Relationship Model defines a hierarchy of entities, with Attributes defined for each level in the hierarchy (e.g. Composite Instance, Frame). X.2.2 Attributes Definition Attributes and matching shall be as defined in section C.2.2 X.3 STANDARD COMPOSITE INSTANCE ROOT RETRIEVE INFORMATION MODEL 285 One standard Composite Instance Root Retrieve Information Model is defined in this Annex. The Composite Instance Root Retrieve Information Model is associated with a number of SOP Classes. The following hierarchical Composite Instance Root Retrieve Information Model is defined: Composite Instance Root 290 X.3.1 Composite Instance Root Information Model The Composite Instance Root Information Model is based upon a two level hierarchy: Composite Instance Frame 295 300 The Composite Instance level is the top level and contains only the SOP Instance UID. The Frame level is below the Composite Instance level and contains only the Attributes that refer to a selection of the frames from a single multi-frame image object. X.3.2 Construction and Interpretation of Frame Range Keys The following rules for the use of Frame Range Keys apply to both an SCU creating such keys and to an SCP interpreting them. X.3.2.1 Frame List Definitions The selection of frames to be included in a new created SOP Instance made in response to a FRAME level Composite Instance Root Retrieve request shall be defined by one of the mechanisms defined in this section, and the list of frames so specified shall be referred to as the Frame List. 305 Notes: 1. Re-ordering of frames is not supported, and order of the frames in the Frame List will always be the same as in the original SOP Instance. 2. New allowable frame selection mechanisms may be defined in the future by the addition of new SOP classes 310 315 X.3.2.1.1 Simple Frame List Simple Frame List (0008,1161) is a multi-valued attribute containing a list of frame numbers, each specifying a frame to be included in the returned object. The first frame of the source instance shall be denoted as frame number 1. The frame numbers in the list shall not contain any duplicates, and shall increase monotonically.

Page 13 Note: Due to the use of UL for this element, a maximum of 16383 values may be specified, as only a 2 byte length is available when an explicit VR Transfer Syntax is used. 320 325 330 X.3.2.1.2 Calculated Frame List Calculated Frame List (0008,1162) is a multi-valued attribute containing a list of 3-tuples, each representing a sub-range of frames to be included in the returned object. The first frame of the source instance shall be denoted as frame number 1.For each 3-tuple:. The first number shall be the frame number of the first frame of the sub-range. The second number shall be the upper limit of the sub-range, and shall be greater than or equal to the first number. The third number shall be the increment between requested frames of the sub-range. This shall be greater than zero. The difference between the first and second numbers is not required to be an exact multiple of the increment. If the difference between the first and second numbers is an exact multiple of the increment, then the last frame of the sub-range shall be the second number. If the first number is greater than the number of frames in the referenced SOP Instance then that subrange shall be ignored. 335 340 345 The sub-ranges shall be non-overlapping such that the sequence of frame numbers determined by concatenating all the sub-ranges shall not contain any duplicates, and shall increase monotonically. A value of FFFFFFFFH or any value greater than the number of frames in the referenced SOP Instance as the second value shall denote the end of the set of frames in the referenced SOP Instance, and may only occur in the last 3-tuple. Note: X.3.2.1.3 For example, if the Calculated Frame List contains 6 values, 2, 9, 3, 12, FFFFFFFFH, 5 and is applied to an Instance containing 25 frames. The resulting Frame List will contain the values 2, 5, 8, 12, 17 and 22. Time Range Time Range (0008,1163) contains the start and end times to be included in the returned object. Times are in seconds, relative to the value of the Content Time (0008,0033) in the parent object. The range shall include all frames between the specified times including any frames at the specified times. The range may be expanded as a consequence of the format in which the information is stored. Where such expansion occurs, any embedded audio data shall be similarly selected. Under all circumstances, the returned Composite SOP Instance shall retain the relationship between image and audio data. 350 Note: For MPEG-2 this would be to the nearest surrounding Key Frames For JPEG 2000 Part 2, this would be to nearest surrounding precinct or tile boundary Time Range shall only be used to specify extraction from SOP instances where the times of frames can be ascertained using one or more of the following attributes: Frame Time (0018,1063)

Page 14 355 Frame Time Vector (0018,1065) Frame Reference DateTime (0018,9151) in the Frame Content Sequence (0020,9111) 360 X.3.3 New Object Creation at the FRAME level When a C-GET operation is performed on a source Composite Instance at the FRAME level then the SCP shall create a new Composite Instance according to the following rules: 365 The new Composite Instance shall be extracted from the source Composite Instance specified by the SOP Instance UID Unique Key present at the Composite Instance Level. The new Composite Instance shall be an instance of the same SOP Class as the source Composite Instance. The new Composite Instance shall have a new SOP Instance UID. The new Composite Instance shall be a valid SOP Instance. 370 Note: The new Composite Instance is required to be internally consistent and valid. This may require the SCP to make consistent modification of any attributes that reference frames or the relationship between them such as start time, time offsets, and modifying the Per-frame Functional Group Sequence (5200,9230). 375 380 385 The new Composite Instance shall contain the frames from the source Composite Object as requested in the Requested Frame List. The Requested Frame List shall be interpreted according to the rules in Section X.3.2. The frames shall be in the same order as in the source Composite Instance. The new Composite Instance shall include the Frame Extraction Module, which shall contain appropriate Attributes from the identifier of the C-GET or C-MOVE request that caused this instance to be created. If the Frame Extraction Module already exists in the source Composite Instance, then a new item shall be appended as an additional item into the Frame Extraction Sequence. The new Composite Instance shall contain the Contributing Equipment Sequence (0018,A001). If the source Composite Object contains the Contributing Equipment Sequence, then a new Item shall be appended to the copy of the sequence in the new Composite Instance, and if the source Composite Object does not contain the Contributing Equipment Sequence, then it shall be created, containing one new Item. In either case, the new Item shall describe the equipment that is extracting the frames, and the Purpose of Reference Code Sequence (0040,A170) within the Item shall be (109105, DCM, Frame Extracting Equipment"). 390 Note: The existing General Equipment module cannot be used to hold details of the creating equipment, as it is a Series level module. The new Composite Instance is part of the same Series as the source Instance, and therefore the Series level information cannot be altered. The new Composite Instance shall have the same Patient, Study and Series level information as the source Instance, including Study and Series Instance UIDs.

Page 15 395 400 The new Composite Instance shall have the same values for the Attributes of the Image Pixel Module of the source Composite Instance except that the Pixel Data URL (0028,7FE0) attribute shall not be present, Pixel Data (7FE0,0010) shall be replaced by the subset of frames, as specified in section X.3.3, and Number of Frames (0028,0008) shall contain the number of frames in the new Composite Instance. The new Composite Instance shall have the same values for other Type 1 and Type 2 Image level attributes that are not otherwise specified. Other attributes may be included in the new Composite Instance if consistent with the new Composite Instance. Note: In most cases private attributes should not be copied unless their full significance is known. See Annex ZZ in Part 17 for more guidance. 405 The new Composite Instance shall not be contained in a Concatenation. This means that it shall not contain a Concatenation UID (0020,9161) attribute or other Concatenation attributes. If the existing Composite Instance contains such attributes, they shall not be included in the new Composite Instance. 410 X.4 DIMSE-C SERVICE GROUPS A single DIMSE-C Service is used in the construction of SOP Classes of the Composite Instance Root Retrieve Service. The following DIMSE-C operation is used: 415 420 425 X.4.1 C-MOVE C-GET C-MOVE Operation SCUs of the Composite Instance Root Retrieve Service shall generate retrievals using the C-MOVE operation as described in PS 3.7. The C-MOVE operation allows an application entity to instruct another application entity to transfer stored SOP Instances or new SOP Instances extracted from such stored SOP Instances to another application entity using the C-STORE operation. Support for the C-MOVE service shall be agreed upon at Association establishment time by both the SCU and SCP of the C-MOVE in order for a C-MOVE operation to occur over the Association. The C-STORE sub-operations shall always be accomplished over an Association different from the Association that accomplishes the CMOVE operation. Hence, the SCP of the Query/Retrieve Service Class serves as the SCU of the Storage Service Class. Note: The application entity that receives the stored SOP Instances may or may not be the originator of the C- MOVE operation. A C-MOVE request may be performed to any level of the Composite Object Instance Root Retrieve Information Model, and the expected SCP behavior depends on the level selected. 430 X.4.1.1 X.4.1.1.1 C-MOVE Service Parameters SOP Class UID The SOP Class UID identifies the Query/Retrieve Information Model against which the C-MOVE is to be performed. Support for the SOP Class UID is implied by the Abstract Syntax UID of the Presentation Context used by this C-MOVE operation.

Page 16 435 440 X.4.1.1.2 Priority The Priority Attribute defines the requested priority of the C-MOVE operation and corresponding C-STORE sub-operations with respect to other DIMSE operations being performed by the same SCP. Processing of priority requests is not required of SCPs. Whether or not an SCP supports priority processing, and the meaning of the different priority levels shall be stated in the Conformance Statement of the SCP. The same priority shall be used for all C-STORE sub-operations. X.4.1.1.3 Identifier The C-MOVE request shall contain an Identifier. The C-MOVE response shall conditionally contain an Identifier as required in C.4.3.1.3.2. 445 Note: The Identifier is specified as U in the definition of the C-MOVE primitive in PS 3.7 but is specialized for use with this service. X.4.1.1.3.1 Request Identifier Structure An Identifier in a C-MOVE request shall contain: 450 the Query/Retrieve Level (0008,0052) that defines the level of the retrieval SOP Instance UID(s) (0008,0018) One of the Frame Range Keys if present in the Information Model for the level of the Retrieval Specific Character Set (0008,0005) shall not be present. 455 The Keys at each level of the hierarchy and the values allowable for the level of the retrieval shall be defined in the SOP Class definition for the Query/Retrieve Information Model. X.4.1.1.4 Status The status code values that might be returned in a C-MOVE response shall be as specified in Table X.4-1 Service Status Failure Table X.4-1 C-MOVE RESPONSE STATUS VALUES FOR INSTANCE ROOT RETRIEVE Further Meaning Status Codes Refused: Out of Resources Unable to calculate number of matches Refused: Out of Resources Unable to perform sub-operations Related Fields A701 (0000,0902) A702 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Refused: Move Destination unknown A801 (0000,0902) Identifier does not match SOP Class A900 (0000,0901) (0000,0902) Unable to process Cxxx (0000,0901) (0000,0902) None of the frames requested were found in the AA00 (0000,0902)

Page 17 460 SOP Instance Unable to create new object for this SOP class AA01 (0000,0902) Unable to extract frames AA02 (0000,0902) Time-based request received for a non-time-based original SOP Instance. AA03 (0000,0902) Invalid Request AA04 (0000,0901) (0000,0902) Cancel Sub-operations terminated due to Cancel Indication FE00 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Warning Sub-operations Complete One or more Failures or Warnings B000 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Success Sub-operations Complete No Failures or Warnings 0000 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Pending Sub-operations are continuing FF00 (0000,1020) (0000,1021) (0000,1022) (0000,1023) X.4.1.1.5 Number of Remaining Sub-Operations Inclusion of the Number of Remaining Sub-operations shall be as specified in C.4.2.1.6 X.4.1.1.6 Number of Completed Sub-Operations Inclusion of the Number of Completed Sub-operations shall be as specified in C.4.2.1.7 465 X.4.1.1.7 Number of Failed Sub-Operations Inclusion of the Number of Failed Sub-operations shall be as specified in C.4.2.1.8 X.4.1.1.8 Number of Warning Sub-Operations Inclusion of the Number of Warning Sub-operations shall be as specified in C.4.2.1.9. 470 475 X.4.1.2 C-MOVE SCU Behavior An SCU conveys the following semantics with a C-MOVE request: If the Retrieve Level (0000,0052) is IMAGE, the SCU shall specify one SOP Instance UID or a list of SOP Instance UIDs. If the Retrieve Level (0000,0052) is FRAME, the SCU shall specify the single SOP Instance UID of the item from which the new Composite SOP Instance should be extracted and the requested Frame List. The Requested Frame List shall be constructed as defined in X.3.2.

Page 18 480 485 490 495 500 Note: The SCU shall accept C-MOVE responses with status equal to Pending during the processing of the C-STORE sub-operations. These responses indicate the number of Remaining, Completed, Failed and Warning C-STORE sub-operations. The SCU shall interpret a C-MOVE response with a status equal to Success, Warning, Failure, or Refused as a final response. The final response indicates the number of Completed suboperations and the number of Failed C-STORE sub-operations resulting from the C-MOVE operation. The SCU shall interpret a status of: o o Success to indicate that all sub-operations were successfully completed Failure or Refused to indicate all sub-operations were unsuccessful o Warning in all other cases. The Number of Completed Sub-Operations (0000,1021), Number of Warning Sub-Operations (0000,1023), Number of Failed Sub-Operations (0000,1022) can be used to obtain more detailed information. The SCU may cancel the C-MOVE operation by issuing a C-MOVE-CANCEL request at any time during the processing of the C-MOVE request. A C-MOVE response with a status of Canceled shall indicate to the SCU that the retrieve was canceled. Optionally, the C-MOVE response with a status of Canceled shall indicate the number of Completed, Failed, and Warning C-STORE sub-operations. If present, the Remaining sub-operations count shall contain the number of C-STORE sub-operations that were not initiated due to the C-MOVE- CANCEL request. For FRAME level C-MOVE operations, the application receiving the C-STORE sub-operations will receive a new SOP Instance with a different SOP Instance UID from the one included in the C-MOVE request. If it is required to link the received instance to the request, then it may be necessary to inspect the Frame Extraction Sequence of the instance received, to compare the original Instance UID and Requested Frame List to those in the request. X.4.1.3 C-MOVE SCP Behavior An SCP conveys the following semantics with a C-MOVE response: 505 510 515 If the Retrieve Level (0000,0052) is IMAGE the SCP shall identify a set of Entities at the level of the transfer based upon the values in the Unique Keys in the Identifier of the C-MOVE request. If the Retrieve Level (0000,0052) is FRAME, the SCP shall create a new Composite Instance according to the rules in section X.3.2. The newly created SOP Instance shall be treated in the same manner as the set of Entities identified above. The SCP shall either re-use an established and compatible Association or establish a new Association for the C-STORE sub-operations The SCP shall initiate C-STORE sub-operations over the Association for the identified or newly created SOP Instances. A sub-operation is considered a Failure if the SCP is required to create new SOP Instance, but is unable to do so due to inconsistencies in the Frame Range Keys, or if the resulting SOP Instance would not be valid. Optionally, the SCP may generate responses to the C-MOVE with status equal to Pending during the processing of the C-STORE sub-operations. These responses shall indicate the number of Remaining, Completed, Failure, and Warning C-STORE sub-operations.

Page 19 520 525 530 535 540 X.4.2 When the number of Remaining sub-operations reaches zero, the SCP shall generate a final response with a status equal to Success, Warning or Failed. The status contained in the C- MOVE response shall contain: o o Success if all sub-operations were successfully completed Failure if all sub-operations were unsuccessful o Warning in all other cases. The SCP may receive a C-MOVE-CANCEL request at any time during the processing of the C-MOVE request. The SCP shall interrupt all C-STORE sub-operation processing and return a status of Canceled in the C-MOVE response. The C-MOVE response with a status of Canceled shall contain the number of Completed, Failed, and Warning C-STORE suboperations. If present, the Remaining sub-operations count shall contain the number of C- STORE sub-operations that were not initiated due to the C-MOVE-CANCEL request. If the SCP manages images in multiple alternate encodings (see C.6.1.1.5.1), only one of the alternate encodings of an image shall be used as the existing SOP Instance from which frames are to be extracted. C-GET Operation SCUs of the Composite Instance Root Retrieve Service shall generate retrievals using the C-GET operation as described in PS 3.7. The C-GET operation allows an application entity to instruct another application entity to transfer stored SOP Instances or new SOP Instances derived from such stored SOP Instances to the initiating application entity using the C-STORE operation. Support for the C-GET service shall be agreed upon at Association establishment time by both the SCU and SCP of the C-GET in order for a C-GET operation to occur over the Association. The C-STORE Sub-operations shall be accomplished on the same Association as the C-GET operation. Hence, the SCP of the Query/Retrieve Service Class serves as the SCU of the Storage Service Class. 545 Note: The Application Entity that receives the stored SOP Instances is always the originator of the C-GET operation. A C-GET request may be performed to any level of the Composite Instance Root Retrieve Information Model, and the expected SCP behavior depends on the level selected. 550 555 560 X.4.2.1 X.4.2.1.1 C-GET Service Parameters SOP Class UID The SOP Class UID identifies the Query/Retrieve Information Model against which the C-GET is to be performed. Support for the SOP Class UID is implied by the Abstract Syntax UID of the Presentation Context used by this C-GET operation. X.4.2.1.2 Priority The Priority Attribute defines the requested priority of the C-GET operation and corresponding C-STORE sub-operations with respect to other DIMSE operations being performed by the same SCP. Processing of priority requests is not required of SCPs. Whether or not an SCP supports priority processing, and the meaning of the different priority levels shall be stated in the Conformance Statement of the SCP. The same priority shall be used for all C-STORE sub-operations.

Page 20 X.4.2.1.3 Identifier The C-GET request shall contain an Identifier. The C-GET response shall conditionally contain an Identifier as required in C.4.3.1.3.2. 565 Note: The Identifier is specified as U in the definition of the C-GET primitive in PS 3.7 but is specialized for use with this service. X.4.2.1.3.1 Request Identifier Structure An Identifier in a C-GET request shall contain: 570 the Query/Retrieve Level (0008,0052) that defines the level of the retrieval SOP Instance UID(s) (0008,0018) One of the Frame Range Keys if present in the Information Model for the level of the Retrieval Specific Character Set (0008,0005) shall not be present. 575 The Keys at each level of the hierarchy and the values allowable for the level of the retrieval shall be defined in the SOP Class definition for the Query/Retrieve Information Model. X.4.2.1.4 Status The status code values that might be returned in a C-GET response shall be as specified in Table X.4-1 Service Status Failure Table X.4-1 C-GET RESPONSE STATUS VALUES FOR INSTANCE ROOT RETRIEVE Further Meaning Status Codes Refused: Out of Resources Unable to calculate number of matches Refused: Out of Resources Unable to perform sub-operations Related Fields A701 (0000,0902) A702 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Identifier does not match SOP Class A900 (0000,0901) (0000,0902) Unable to process Cxxx (0000,0901) (0000,0902) None of the frames requested were found in the SOP Instance AA00 (0000,0902) Unable to create new object for this SOP class AA01 (0000,0902) Unable to extract frames AA02 (0000,0902) Time-based request received for a non-time-based original SOP Instance. AA03 (0000,0902) Invalid Request AA04 (0000,0901) (0000,0902) Cancel Sub-operations terminated due to Cancel Indication FE00 (0000,1020)

Page 21 580 Warning Sub-operations Complete One or more Failures or Warnings (0000,1021) (0000,1022) (0000,1023) B000 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Success Sub-operations Complete No Failures or Warnings 0000 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Pending Sub-operations are continuing FF00 (0000,1020) (0000,1021) (0000,1022) (0000,1023) X.4.2.1.5 Number of Remaining Sub-Operations Inclusion of the Number of Remaining Sub-operations shall be as specified in C.4.3.1.5 X.4.2.1.6 Number of Completed Sub-Operations Inclusion of the Number of Completed Sub-operations shall be as specified in C.4.3.1.6 585 X.4.2.1.7 Number of Failed Sub-Operations Inclusion of the Number of Failed Sub-operations shall be as specified in C.4.3.1.7 X.4.2.1.8 Number of Warning Sub-Operations Inclusion of the Number of Warning Sub-operations shall be as specified in C.4.3.1.8. 590 595 600 X.4.2.2 C-GET SCU Behavior An SCU conveys the following semantics with a C-GET request: If the Retrieve Level (0000,0052) is IMAGE, the SCU shall specify one SOP Instance UID or a list of SOP Instance UIDs. If the Retrieve Level (0000,0052) is FRAME, the SCU shall specify the single SOP Instance UID of the item from which the new Composite SOP Instance should be extracted and the Requested Frame List. The Requested Frame List shall be constructed as a Frame List as defined in X.3.2. The SCU shall have proposed sufficient presentation contexts at Association establishment time to accommodate expected C-STORE sub-operations that will occur over the same Association. The SCU of the Query/Retrieve Service Class shall serve as the SCP of the Storage Service Class. The SCU shall accept C-GET responses with status equal to Pending during the processing of the C-STORE sub-operations. These responses indicate the number of Remaining, Completed, Failed and Warning C-STORE sub-operations.

Page 22 605 610 615 620 625 630 635 640 645 X.4.2.3 The SCU shall interpret a C-GET response with a status equal to Success, Warning, Failure, or Refused as a final response. The final response indicates the number of Completed suboperations and the number of Failed C-STORE sub-operations resulting from the C-GET operation. The SCU shall interpret a status of: o o Success to indicate that all sub-operations were successfully completed Failure or Refused to indicate all sub-operations were unsuccessful o Warning in all other cases. The Number of Completed Sub-Operations (0000,1021), Number of Warning Sub-Operations (0000,1023), Number of Failed Sub-Operations (0000,1022) can be used to obtain more detailed information. The SCU may cancel the C-GET operation by issuing a C-GET-CANCEL request at any time during the processing of the C-GET request. A C-GET response with a status of Canceled shall indicate to the SCU that the retrieve was canceled. Optionally, the C-GET response with a status of Canceled shall indicate the number of Completed, Failed, and Warning C-STORE sub-operations. If present, the Remaining sub-operations count shall contain the number of C-STORE sub-operations that were not initiated due to the C-GET-CANCEL request. C-GET SCP Behavior An SCP conveys the following semantics with a C-GET response: If the Retrieve Level (0000,0052) is IMAGE the SCP shall identify a set of Entities at the level of the transfer based upon the values in the Unique Keys in the Identifier of the C-GET request. If the Retrieve Level (0000,0052) is FRAME, the SCP shall create a new Composite Instance according to the rules in section X.3.3. The newly created SOP Instance shall be treated in the same manner as the set of Entities identified above. The SCP shall initiate C-STORE sub-operations for the identified or newly created SOP Instances. The SCP of the Query/Retrieve Service Class shall serve as an SCU of the Storage Service Class. The SCP shall initiate C-STORE sub-operations over the same Association for all identified or newly created SOP Instances specified in the C-GET request. A sub-operation is considered a Failure if the SCP is required to create new SOP Instance, but is unable to do so due to inconsistencies in the Frame Range Keys, or if the resulting SOP Instance would not be valid. A sub-operation is considered a Failure if the SCP is unable to initiate a C-STORE suboperation because the Query/Retrieve SCU did not offer an appropriate presentation context for a given stored SOP Instance. Optionally, the SCP may generate responses to the C-GET with status equal to Pending during the processing of the C-STORE sub-operations. These responses shall indicate the number of Remaining, Completed, Failure, and Warning C-STORE sub-operations. When the number of Remaining sub-operations reaches zero, the SCP shall generate a final response with a status equal to Success, Warning or Failed. The status contained in the C- GET response shall contain: o o o Success if all sub-operations were successfully completed Failure if all sub-operations were unsuccessful Warning in all other cases.

Page 23 650 655 The SCP may receive a C-GET-CANCEL request at any time during the processing of the C- GET request. The SCP shall interrupt all C-STORE sub-operation processing and return a status of Canceled in the C-GET response. The C-GET response with a status of Canceled shall contain the number of Completed, Failed, and Warning C-STORE sub-operations. If present, the Remaining sub-operations count shall contain the number of C-STORE suboperations that were not initiated due to the C-GET-CANCEL request. If the SCP manages images in multiple alternate encodings (see C.6.1.1.5.1), only one of the alternate encodings of an image shall be used as the existing SOP Instance from which frames are to be extracted. X.5 ASSOCIATION NEGOTIATION 660 665 Association establishment is the first phase of any instance of communication between peer DICOM AEs. AEs supporting DICOM Query/Retrieve SOP Classes utilize Association establishment negotiation by defining the use of Application Association Information. See PS 3.7 for an overview of Association negotiation. SOP Classes of the Composite Instance Root Retrieve Service, which include retrieval services based on the C-GET operation, use the SCP/SCU Role Selection Sub-Item to identify the SOP Classes that may be used for retrieval. X.5.1 Association Negotiation for C-GET SOP Classes Rules are as specified in C.5.3, except that the Relational-retrieval extended negotiation subitem shall not be used for this service class. 670 X.6 SOP CLASS DEFINITIONS 675 X.6.1 Composite Instance Root SOP Class Group In the Composite Instance Root Retrieve Only Information Model, the information is arranged into two levels that correspond to one of the two values in element (0008,0052) shown in Table X.6.1-1. Table X.6.1-1 Retrieve Level Values for Composite Instance Root Composite Instance Frame Retrieve Level Value in (0008,0052) IMAGE FRAME 680 Note: The use of the word IMAGE rather than Composite Instance is historical to allow backward compatibility with previous versions of the standard. It should not be taken to mean that Composite Instances of other than image type are not included at the level indicated by the value IMAGE.

Page 24 685 X.6.1.1 X.6.1.1.1 Composite Instance Root Retrieve Only Information Model E/R Model The Composite Instance Root Retrieve Only Information Model may be represented by the entity relationship diagram shown in Figure X.6.1-1 Composite Object Instance 1 Contains n Frame FIGURE X.6-1 COMPOSITE INSTANCE ROOT INFORMATION MODEL E/R DIAGRAM 690 695 X.6.1.1.2 Composite Instance Level Table X.6-1 defines the keys at the Composite Instance level of the Composite Instance Root Query/Retrieve Information model. Table X.6-1 COMPOSITE INSTANCE LEVEL KEYS FOR THE COMPOSITE INSTANCE ROOT QUERY/RETRIEVE INFORMATION MODEL Description Tag Matching Key Type SOP Instance UID (0008,0018) U 700 X.6.1.1.3 Frame Level Table X.6-2 defines the keys at the Frame level of the Composite Instance Root Query/Retrieve Information Model. One and only one of the frame level keys listed in Table X.6-2 shall be present in a FRAME level request Table X.6-2 FRAME LEVEL KEYS FOR THE COMPOSITE INSTANCE ROOT QUERY/RETRIEVE INFORMATION MODEL Description Tag Condition Simple Frame List (0008,1161) Required if Calculated Frame List and Time Range are not present

Page 25 705 Calculated Frame List (0008,1162) Required if Simple Frame List and Approximate Frame Range are not present Time Range (0008,1163) Required if Simple Frame List and Calculated Frame List are not present X.6.1.1.4 Scope of the C-MOVE or C-GET Commands and Sub-Operations A C-MOVE or C-GET request may be performed to any level of the Query/Retrieve Model. A C-MOVE or C-GET where the Query/Retrieve level is the: 710 715 720 725 730 735 Note: X.6.1.2 IMAGE level indicates that selected individual Composite Instances shall be transferred FRAME level indicates that a single new Composite Instance shall be created and transferred More than one entity may be retrieved if the Query/Retrieve Level is IMAGE using List of UID matching, but if the Query/Retrieve Level is FRAME then only a single entity may be retrieved. Conformance Requirements An implementation may conform to one of the Composite Instance Root Retrieve SOP Classes as an SCU, SCP or both. The Conformance Statement shall be in the format defined in PS 3.2. X.6.1.2.1 SCU Conformance X.6.1.2.1.1 C-MOVE SCU Conformance An implementation that conforms to one of the Composite Instance Root Retrieve SOP Classes as an SCU shall support transfers against the Retrieve Information Model described in Section X.6.1.1 using the C-MOVE SCU Behavior described in Section X.4.1.2. An implementation that conforms to one of the SOP Classes of the Composite Instance Root SOP Class Group as an SCU, and which generates retrievals using the C-MOVE operation shall state in its Conformance Statement the Storage Service Class SOP Classes under which it shall support the C-STORE sub-operations generated by the C- MOVE. X.6.1.2.1.2 C-GET SCU Conformance An implementation that conforms to one of the Composite Instance Root Retrieve SOP Classes as an SCU shall support retrievals against the Retrieve Information Model described in Section X.6.1.1 using the C-GET SCU Behavior described in Section X.4.2.2. An implementation that conforms to one of the SOP Classes of the Composite Instance Root SOP Class Group as an SCU, which generates retrievals using the C-GET operation shall state in its Conformance Statement the Storage Service Class SOP Classes under which it shall support the C-STORE sub-operations generated by the C-GET. X.6.1.2.2 SCP Conformance An implementation that conforms to one of the Composite Instance Root Retrieve SOP Classes as an SCP for C-GET operations shall: 1) support both levels of the Composite Instance Root Retrieve Only Information Model 2) support all three Frame Level keys 740 3) describe in its conformance statement the transformations it applies to a multi-frame Composite Instance when creating a new Composite Instance as defined in Section X.3.3.

Page 26 745 750 755 X.6.1.2.2.1 C-MOVE SCP Conformance An implementation that conforms to one of the Composite Instance Root Retrieve SOP Classes as an SCP shall support retrievals against both levels of the Retrieve Information Model described in Section X.6.1.1 using the C-MOVE SCP Behavior described in Section X.4.1.3. An implementation that conforms to one of the SOP Classes of the Composite Instance Root SOP Class Group as an SCP, which satisfies retrievals using the C- MOVE operation shall state in its Conformance Statement the Storage Service Class SOP Classes under which it shall support the C-STORE sub-operations generated by the C- MOVE. X.6.1.2.2.2 C-GET SCP Conformance An implementation that conforms to one of the Composite Instance Root Retrieve SOP Classes as an SCP shall support retrievals against both levels of the Retrieve Information Model described in Section X.6.1.1 using the C-GET SCP Behavior described in Section X.4.2.3. An implementation that conforms to one of the SOP Classes of the Composite Instance Root SOP Class Group as an SCP, and which satisfies retrievals using the C-GET operation shall state in its Conformance Statement the Storage Service Class SOP Classes under which it shall support the C-STORE sub-operations generated by the C-GET. X.6.1.3 SOP Classes The SOP Classes in the Composite Instance Root SOP Class Group of the Query/Retrieve Service Class identify the Composite Instance Root Retrieve Only Information Model, and the DIMSE-C operations supported. The Standard SOP Classes are listed in Table X.6.1.3-1. 760 Table X.6.1.3-1 SOP Classes for Composite Instance Query/Retrieve Root UID NAME UID Value Composite Instance Root Retrieve MOVE 1.2.840.10008.5.1.4.1.2.4.2 Composite Instance Root Retrieve GET 1.2.840.10008.5.1.4.1.2.4.3

Page 27 PS 3.4 Insert New Annex Y as follows 765 Annex Y Composite Instance Retrieve Without Bulk Data SOP Classes (Normative) Y.1 OVERVIEW 770 775 Y.1.1 Scope Composite Instance Retrieve Without Bulk Data Service is a service within the DICOM Query/Retrieve Service class defined in Annex C. The retrieve capability of this service allows a DICOM AE to retrieve Composite Instances without retrieving their pixel data or other potentially large attributes as defined in Section Y.1.3. Y.1.2 Composite Instance Retrieve Without Bulk Data Information Model Retrievals are implemented against the Composite Instance Retrieve Without Bulk Data Information Model, as defined in this Annex of the DICOM Standard. A specific SOP Class of the Query/Retrieve Service Class consists of an Information Model Definition and a DIMSE-C Service Group. Y.1.3 Attributes Not Included The attributes that shall not be included in the top level of the Dataset sent by an SCP of this Service are as defined in Table Y.1-1 780 Table Y.1-1 Attributes not to be Included in Instances Sent Attribute Tag Pixel Data (7FE0,0010) Pixel Data URL (7FE0,0120) Spectroscopy Data (5600,0020) Overlay Data Curve Data Audio Sample Data (60xx,3000) (50xx,3000) (50xx,200C) 785 Note: This implies that the pixel data within Icon Image Sequence (0088,0200) Items will be preserved. The Waveform Data (5400,1010) attribute shall not be included within the Waveform Sequence (5400,0100). 790 Y.1.4 Service Definition Two peer DICOM AEs implement a SOP Class of the Composite Instance Retrieve Without Bulk Data Service with one serving in the SCU role and one serving in the SCP role. SOP Classes of the Composite

Page 28 Instance Retrieve Without Bulk Data Service are implemented using the DIMSE-C C-GET service as defined in PS 3.7. The following descriptions of the DIMSE-C C-GET service provide a brief overview of the SCU/SCP semantics: 795 800 805 810 815 a) A C-GET service conveys the following semantics: The SCP shall identify a set of Entities at the level of the retrieval based upon the values in the Unique Keys in the Identifier of the C-GET request. The SCP shall then generate C-STORE sub-operations for the corresponding storage SOP Instances, but shall not include attributes as described in Section Y.1.3 in the data sent during those sub-operations. These C-STORE sub-operations occur on the same Association as the C-GET service and the SCU/SCP roles are reversed for the C-STORE. Note: If the source instance does not contain any of the attributes described in Section Y.1.3 then, the version sent via the C-STORE sub-operation would be identical to the original data. This is not an error. The SCP may optionally generate responses to the C-GET with status equal to Pending during the processing of the C-STORE sub-operations. These C-GET responses indicate the number of remaining C-STORE sub-operations and the number of C-STORE sub-operations returning the status of Success, Warning, and Failed. When the number of Remaining C-STORE sub-operations reaches zero, the SCP generates a final response with a status equal to Success, Warning, Failed, or Refused. This response shall indicate the number of C-STORE sub-operations returning the status of Success, Warning, and Failed. If the status of any C-STORE sub-operation was Failed a UID List shall be returned. The SCU may cancel the C-GET service by issuing a C-GET-CANCEL request at any time during the processing of the C-GET. The SCP terminates all incomplete C-STORE suboperations and returns a status of Canceled. Y.2 COMPOSITE INSTANCE RETRIEVE WITHOUT BULK DATA INFORMATION MODEL DEFINITION 820 The Composite Instance Retrieve Without Bulk Data Information Model is identified by the SOP Class negotiated at Association establishment time. The SOP Class is composed of both an Information Model and a DIMSE-C Service Group. Note: This SOP Class identifies the class of the Composite Instance Retrieve Without Bulk Data Information Model (i.e. not the SOP Class of the stored SOP Instances for which the SCP has information) 825 830 Information Model Definitions for standard SOP Classes of the Composite Instance Retrieve Without Bulk Data Service are defined in this Annex. A Composite Instance Retrieve Without Bulk Data Information Model Definition contains: Entity-Relationship Model Definition Key Attributes Definition

Page 29 Y.2.1 Entity-Relationship Model Definition For any Composite Instance Retrieve Without Bulk Data Information Model, an Entity-Relationship Model defines a hierarchy of entities, with Attributes defined for each level in the hierarchy (e.g. Composite Instance, Frame). 835 Y.2.2 Attributes Definition Attributes and matching shall be as defined in section C.2.2 Y.3 STANDARD COMPOSITE INSTANCE RETRIEVE WITHOUT BULK DATA INFORMATION MODEL 840 One standard Composite Instance Retrieve Without Bulk Data Information Model is defined in this Annex. The Composite Instance Retrieve Without Bulk Data Information Model is associated with a single SOP Class. The following Composite Instance Retrieve Without Bulk Data Information Model is defined: Retrieve Without Bulk Data 845 Y.3.1 Composite Instance Retrieve Without Bulk Data Information Model The Composite Instance Retrieve Without Bulk Data Information Model is based upon a one level hierarchy: Composite Instance 850 The Retrieve Without Bulk Data Information Model may be represented by the entity relationship diagram shown in Figure Y.3.1-1. Composite Object Instance FIGURE Y.3.1-1 RETRIEVE WITHOUT BULK DATA INFORMATION MODEL E/R DIAGRAM 855 The Composite Instance level is the only level and contains only the SOP Instance UID. Y.4 DIMSE-C SERVICE GROUPS A single DIMSE-C Service is used in the construction of SOP Classes of the Composite Instance Retrieve Without Bulk Data Service. The following DIMSE-C operation is used: 860 865 Y.4.1 C-GET C-GET Operation SCUs of the Composite Instance Retrieve Without Bulk Data Service shall generate retrievals using the C- GET operation as described in PS 3.7. The C-GET operation allows an application entity to instruct another application entity to transfer SOP Instances without the Attributes as described in Section Y.1.3 to the initiating application entity using the C-STORE operation. Support for the C-GET service shall be

Page 30 agreed upon at Association establishment time by both the SCU and SCP of the C-GET in order for a C- GET operation to occur over the Association. The C-STORE Sub-operations shall be accomplished on the same Association as the C-GET operation. Hence, the SCP of the Query/Retrieve Service Class serves as the SCU of the Storage Service Class. 870 Note: The Application Entity that receives the stored SOP Instances is always the originator of the C-GET operation. 875 880 Y.4.2.1 Y.4.2.1.1 C-GET Service Parameters SOP Class UID The SOP Class UID identifies the Query/Retrieve Information Model against which the C-GET is to be performed. Support for the SOP Class UID is implied by the Abstract Syntax UID of the Presentation Context used by this C-GET operation. Y.4.2.1.2 Priority The Priority Attribute defines the requested priority of the C-GET operation and corresponding C-STORE sub-operations with respect to other DIMSE operations being performed by the same SCP. Processing of priority requests is not required of SCPs. Whether or not an SCP supports priority processing, and the meaning of the different priority levels shall be stated in the Conformance Statement of the SCP. The same priority shall be used for all C-STORE sub-operations. 885 Y.4.2.1.3 Identifier The C-GET request shall contain an Identifier. The C-GET response shall conditionally contain an Identifier as required in C.4.3.1.3.2. Note: The Identifier is specified as U in the definition of the C-GET primitive in PS 3.7 but is specialized for use with this service. 890 Y.4.2.1.3.1 Request Identifier Structure An Identifier in a C-GET request shall contain: the Query/Retrieve Level (0008,0052) that defines the level of the retrieval SOP Instance UID(s) (0008,0018) 895 Query/Retrieve Level (0008,0052) shall be IMAGE. Specific Character Set (0008,0005) shall not be present. The Keys at each level of the hierarchy and the values allowable for the level of the retrieval are defined in the SOP Class definition for the Query/Retrieve Information Model. 900 Y.4.2.1.4 Status The status code values that might be returned in a C-GET response shall be as specified in Table Y.4-1 Table Y.4-1 C-GET RESPONSE STATUS VALUES FOR INSTANCE ROOT RETRIEVE Service Further Meaning Status Related

Page 31 Status Codes Fields Failure Refused: Out of Resources Unable to calculate A701 (0000,0902) number of matches Refused: Out of Resources Unable to perform sub-operations A702 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Identifier does not match SOP Class A900 (0000,0901) (0000,0902) Unable to process Cxxx (0000,0901) (0000,0902) Cancel Sub-operations terminated due to Cancel Indication FE00 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Warning Sub-operations Complete One or more Failures or Warnings B000 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Success Sub-operations Complete No Failures or Warnings 0000 (0000,1020) (0000,1021) (0000,1022) (0000,1023) Pending Sub-operations are continuing FF00 (0000,1020) (0000,1021) (0000,1022) (0000,1023) 905 Y.4.2.1.5 Number of Remaining Sub-Operations Inclusion of the Number of Remaining Sub-operations shall be as specified in C.4.3.1.5 Y.4.2.1.6 Number of Completed Sub-Operations Inclusion of the Number of Completed Sub-operations shall be as specified in C.4.3.1.6 Y.4.2.1.7 Number of Failed Sub-Operations Inclusion of the Number of Failed Sub-operations shall be as specified in C.4.3.1.7 910 Y.4.2.1.8 Number of Warning Sub-Operations Inclusion of the Number of Warning Sub-operations shall be as specified in C.4.3.1.8. Y.4.2.2 C-GET SCU and C-STORE SCP Behavior An SCU conveys the following semantics with a C-GET request: The SCU shall specify one Instance UID or a list of Instance UIDs.

Page 32 915 920 925 930 935 940 The SCU shall have proposed sufficient presentation contexts at Association establishment time to accommodate expected C-STORE sub-operations that will occur over the same Association. The SCU of the Query/Retrieve Service Class shall serve as the SCP of the Storage Service Class. The SCP of the Storage Service Class shall not store the incomplete SOP Instance; rather the behavior is implementation defined. The SCU shall accept C-GET responses with status equal to Pending during the processing of the C-STORE sub-operations. These responses indicate the number of Remaining, Completed, Failed and Warning C-STORE sub-operations. The SCU shall interpret a C-GET response with a status equal to Success, Warning, Failure, or Refused as a final response. The final response indicates the number of Completed suboperations and the number of Failed C-STORE sub-operations resulting from the C-GET operation. The SCU shall interpret a status of: o o Success to indicate that all sub-operations were successfully completed Failure or Refused to indicate all sub-operations were unsuccessful o Warning in all other cases. The Number of Completed Sub-Operations (0000,1021), Number of Warning Sub-Operations (0000,1023), Number of Failed Sub-Operations (0000,1022) can be used to obtain more detailed information. The SCU may cancel the C-GET operation by issuing a C-GET-CANCEL request at any time during the processing of the C-GET request. A C-GET response with a status of Canceled shall indicate to the SCU that the retrieve was canceled. Optionally, the C-GET response with a status of Canceled shall indicate the number of Completed, Failed, and Warning C-STORE sub-operations. If present, the Remaining sub-operations count shall contain the number of C-STORE sub-operations that were not initiated due to the C-GET-CANCEL request. The SCP of the Storage Service Class shall not return a status of Error: Dataset does not match SOP Class (A9xx) or Warning: Dataset does not match SOP Class (B007) due to the absence of the Attributes described in Section Y.1.3. Y.4.2.3 C-GET SCP and C-STORE SCU Behavior An SCP conveys the following semantics with a C-GET response: 945 950 955 The SCP shall identify a set of Entities at the level of the transfer based upon the values in the Unique Keys in the Identifier of the C-GET request. The SCP shall initiate C-STORE sub-operations for the identified SOP Instances, but shall not include in this C-STORE sub-operation the Attributes described in section Y.1.3. The SCP of the Query/Retrieve Service Class shall serve as an SCU of the Storage Service Class. Apart from the Attributes listed in section Y.1.3, the SOP Instance sent via the C-STORE suboperation shall be unchanged, and no corresponding changes to other attributes shall be made. Note: In particular, the Study, Series and SOP Instance UIDs and SOP Class UID will not be altered. The SCP shall initiate C-STORE sub-operations over the same Association for all SOP Instances specified in the C-GET request. A sub-operation is considered a Failure if the SCP is unable to initiate a C-STORE suboperation because the Query/Retrieve SCU did not offer an appropriate presentation context for a given stored SOP Instance.

Page 33 960 965 970 975 Optionally, the SCP may generate responses to the C-GET with status equal to Pending during the processing of the C-STORE sub-operations. These responses shall indicate the number of Remaining, Completed, Failure, and Warning C-STORE sub-operations. When the number of Remaining sub-operations reaches zero, the SCP shall generate a final response with a status equal to Success, Warning or Failed. The status contained in the C- GET response shall contain: o o o Success if all sub-operations were successfully completed Failure if all sub-operations were unsuccessful Warning in all other cases. The SCP may receive a C-GET-CANCEL request at any time during the processing of the C- GET request. The SCP shall interrupt all C-STORE sub-operation processing and return a status of Canceled in the C-GET response. The C-GET response with a status of Canceled shall contain the number of Completed, Failed, and Warning C-STORE sub-operations. If present, the Remaining sub-operations count shall contain the number of C-STORE suboperations that were not initiated due to the C-GET-CANCEL request. If the SCP manages images in multiple alternate encodings (see C.6.1.1.5.1), only one of the alternate encodings of an image shall be used as the existing SOP Instance from which frames are to be extracted. Y.5 ASSOCIATION NEGOTIATION 980 985 Association establishment is the first phase of any instance of communication between peer DICOM AEs. AEs supporting DICOM Query/Retrieve SOP Classes utilize Association establishment negotiation by defining the use of Application Association Information. See PS 3.7 for an overview of Association negotiation. SOP Classes of the Composite Instance Retrieve Without Bulk Data Service, which include retrieval services based on the C-GET operation, use the SCP/SCU Role Selection Sub-Item to identify the SOP Classes that may be used for retrieval. Y.5.1 Association Negotiation for C-GET SOP Classes Rules are as specified in C.5.3, except that the Relational-retrieval extended negotiation subitem shall not be used for this service class. 990 Y.6 SOP CLASS DEFINITIONS Y.6.1 Composite Instance Retrieve Without Bulk Data SOP Class Group In the Composite Instance Retrieve Without Bulk Data Only Information Model, only a single Retrieve Level is used. 995 Table Y.6.1-1 Retrieve Level Value for Retrieve Without Bulk Data

Page 34 Retrieve Level Composite Instance Value in (0008,0052) IMAGE 1000 Note: The use of the word IMAGE rather than Composite Instance is historical to allow backward compatibility with previous versions of the standard. It should not be taken to mean that Composite Instances of other than image type are not included at the level indicated by the value IMAGE. 1005 Y.6.1.1 Composite Instance Retrieve Without Bulk Data Information Model Y.6.1.1.1 E/R Model The Composite Instance Retrieve Without Bulk Data Only Information Model has only a single level: IMAGE. Y.6.1.1.2 Composite Instance Level Table Y.6-1 defines the keys at the Composite Instance level of the Composite Instance Retrieve Without Bulk Data Query/Retrieve Information model. 1010 Table Y.6-1 COMPOSITE INSTANCE LEVEL KEYS FOR THE COMPOSITE INSTANCE ROOT QUERY/RETRIEVE INFORMATION MODEL Description Tag Matching Key Type SOP Instance UID (0008,0018) U 1015 Y.6.1.1.3 Scope of the C-GET Commands and Sub-Operations A C-GET request may only be performed at the IMAGE level of the Query/Retrieve Model. A C-GET indicates that selected individual Composite Instances, without bulk data attributes shall be transferred. 1020 1025 Y.6.1.2 Conformance Requirements An implementation may conform to one of the SOP Classes of the Composite Instance Retrieve Without Bulk Data SOP Class Group as an SCU, SCP or both. The Conformance Statement shall be in the format defined in PS 3.2. Y.6.1.2.1 SCU Conformance An implementation that conforms to one of the SOP Classes of the Composite Instance Retrieve Without Bulk Data SOP Class Group as an SCU shall support retrievals against the Query/Retrieve Information Model described in Section Y.6.1.1 using the C-GET SCU Behavior described in Section Y.4.2.2. An implementation that conforms to one of the SOP Classes of the Composite Instance Retrieve Without Bulk Data SOP Class Group as an SCU, and which generates retrievals using the C-GET operation shall state in its Conformance Statement the Storage Service Class SOP Classes under which it shall support the C- STORE sub-operations generated by the C-GET.

Page 35 1030 1035 1040 Y.6.1.2.2 SCP Conformance An implementation that conforms to one of the SOP Classes of the Composite Instance Retrieve Without Bulk Data SOP Class Group as an SCP shall support retrievals against both levels of the Retrieve Information Model described in Section Y.6.1.1 using the C-GET SCP Behavior described in Section Y.4.2.3. An implementation that conforms to one of the SOP Classes of the Composite Instance Retrieve Without Bulk Data SOP Class Group as an SCP, and which satisfies retrievals using the C-GET operation shall state in its Conformance Statement the Storage Service Class SOP Classes under which it shall support the C-STORE sub-operations generated by the C-GET. Y.6.1.3 SOP Classes The SOP Classes in the Composite Instance Retrieve Without Bulk Data SOP Class Group of the Query/Retrieve Service Class identify the Composite Instance Retrieve Without Bulk Data Only Information Model, and the DIMSE-C operations supported. The Standard SOP Classes are listed in Table Y.6.1.3-1. Table Y.6.1.3-1 SOP Classes for Composite Instance Query/Retrieve Root UID NAME UID Value Composite Instance Retrieve Without Bulk Data GET 1.2.840.10008.5.1.4.1.2.5.3

Page 36 1045 Changes to NEMA Standards Publication PS 3.6-2008 Digital Imaging and Communications in Medicine (DICOM) Part 6: Data Dictionary PS 3.6: Add the following data elements to Section 6: 1050 Tag Name VR VM (0008,1161) Simple Frame List UL 1-n (0008,1162) Calculated Frame List UL 3-3n (0008,1163) Time Range FD 2 (0008,1164) Frame Extraction Sequence SQ 1 (0008,1167) Multi-Frame Source SOP Instance UID UI 1 PS 3.6: Add the following UIDs to Annex A: UID Value UID NAME Category 1.2.840.10008.5.1.4.1.2.4.2 Composite Instance Root Retrieve MOVE 1.2.840.10008.5.1.4.1.2.4.3 Composite Instance Root Retrieve GET 1.2.840.10008.5.1.4.1.2.5.3 Composite Instance Retrieve Without Bulk Data GET SOP Class SOP Class SOP Class PS3.4 PS3.4 PS3.4

Page 37 1055 Changes to NEMA Standards Publication PS 3.16-2008 Digital Imaging and Communications in Medicine (DICOM) Part 16: Explanatory Information Append to CID 7005 Contributing Equipment Purposes of Reference Context ID 7005 : Contributing Equipment Purposes of Reference Coding Scheme Designator (0008,0102) Code Value (0008,0100) Code Meaning (0008,0104) DCM 109105 Frame Extracting Equipment 1060 Add to the Table in Annex D 109105 Frame Extracting Equipment Equipment that has processed composite instances to create new composite instances by extracting selected frames from the original instance.

Page 38 Changes to NEMA Standards Publication PS 3.17-2008 Digital Imaging and Communications in Medicine (DICOM) 1065 Part 17: Explanatory Information PS 3.17: Add the following Annexes: Annex ZX Use Cases for the Composite Instance Root Retrieval Classes The use cases fall into five broad groups: 1070 ZX.1 CLINICAL REVIEW 1075 1080 ZX.1.1 Retrieval based on report references A referring physician receives radiological diagnostic reports on CT or MRI examinations. These reports contain references to specific images. He chooses to review these specific images himself and/or show the patient. The references in the report point to particular slices. If the slices are individual images, then they may be obtained individually. If the slices are part of an enhanced multi-frame CT/MR object, then retrieval of the whole multi-frame object might take too long. The Composite Instance Root Retrieve Service allows retrieval of only the selected frames. The source of the image and frame references in the report could be KOS, CDA, SR, presentation states or other sources. Selective retrieval can also be used to retrieve 2 or more arbitrary frames, as may be used for digital subtraction (masking), and may be used with any multi-frame objects, including multi-frame ultrasound, XR etc. 1085 1090 Features of interest in many long video examinations (e.g. endoscopy) are commonly referenced as times from the start of the examination. The same benefits of reduced WAN bandwidth use could be obtained by shortening the MPEG-2 or JPEG 2000 Part 2 Multi-component based stream prior to transmission. ZX.1.2 Selective retrieval without references to specific slices Retrieval using the Composite Instance Retrieve Without Bulk Data Retrieve Service allows determination and retrieval of a suitable subset of frames. This could for instance be used to retrieve only the slices with particular imaging characteristics (e.g. T2 weighting from an enhanced MR object). ZX.2 LOCAL USE RELEVANT PRIORS 1095 ZX.2.1 Anatomic sub-region A multi-frame CT or MR may cover a larger area of anatomy than is required for use as a relevant prior. How the SCU determines which frames are relevant is outside the scope of the standard.

Page 39 ZX.2.2 Worklists Relevant priors may be specified by instance and frame references in a worklist and benefit from the same facilities. ZX.3 ATTRIBUTE BASED RETRIEVAL 1100 There are times when it would be useful to retrieve from a multi-frame image only those frames satisfying certain dimensionality criteria, such as those CT slices fitting within a chosen volume. Initial retrieval of the image using the Composite Instance Retrieve Without Bulk Data Retrieve Service allows determination and retrieval of a suitable sub-set of frames. ZX.4 CAD & DATA MINING APPLICATIONS 1105 Given the massively enhanced amount of dimensional information in the new CT/MR objects, applications could be developed that would use this for statistical purposes without needing to fetch the whole (correspondingly large) pixel data set. The Composite Instance Retrieve Without Bulk Data Retrieve Service permits this. ZX.5 INDEPENDENT WADO SERVER 1110 A hospital has a large PACS (that supports multi-frame objects) that does not support WADO. The hospital installs a separate WADO server that obtains images from the PACS using DICOM. WADO has the means to request individual frames, supporting many of the above use cases. Annex ZY Example SCU use of the Composite Instance Root Retrieval Classes ZY.1 RETRIEVAL OF ENTIRE COMPOSITE INSTANCES 1115 1120 There are many modules in DICOM that use the Image SOP Instance Reference Macro (PS 3.4 Table 10-3), which includes the SOP Instance UID and SOP class UID, but not the Series Instance UID and Study Instance UID. Using the Composite Instance Root Retrieval Classes however, retrieval of such instances is simple, as a direct retrieval may be requested, including only the SOP Instance UID in the Identifier of the C-GET request. ZY.2 RETRIEVAL OF SELECTED FRAME COMPOSITE INSTANCES FROM MULTI-FRAME OBJECTS Where the frames to be retrieved and viewed are known in advance, - e.g. when they are referenced by an Image Reference Macro in a structured report, then they may be retrieved directly using either of the Composite Instance Root Retrieval Classes. 1125 ZY.3 RETRIEVAL OF SELECTED FRAME COMPOSITE INSTANCES FROM MPEG-2 VIDEO If the image has been stored in MPEG-2 format, and if the SCU has knowledge independent of DICOM as to which section of a video is required for viewing (e.g. perhaps notes from an endoscopy) then the SCU can perform the following steps: 1) Use known configuration information to identify the available transfer syntaxes

Page 40 1130 2) If MPEG-2 or JPEG 2000 Part 2 Multi-component transfer syntaxes are available, then issue a request to retrieve the required section. The data received may be slightly longer than that requested, depending on the position of key frames in the data. 1135 3) If only other transfer syntaxes are available, then the SCU may need to retrieve most of the object using Composite Instance Retrieve Without Bulk Data Retrieve Service to find the frame rate or frame time vector, and then calculate a list of frames to retrieve as in the previous sections.

Page 41 Annex ZZ Considerations for Applications Creating New Images from Multi-Frame Images ZZ.1 SCOPE 1140 The purpose of this annex is to aid those developing SCPs of the Composite Instance Root Retrieve Service Class. The behavior of the application when making any of the changes discussed in this annex should be documented in the conformance statement of the application. ZZ.2 FRAME EXTRACTION ISSUES 1145 There are many different aspects to consider when extracting frames to make a new object, to ensure that the new image remains a fully valid SOP Instance, and the following is a non-exhaustive list of important issues ZZ.2.1 Number of Frames The Number of Frames (0028,0008) attribute will need to be updated. 1150 1155 1160 1165 ZZ.2.2 Start and End Times Any attributes that refer to start and end times such as Acquisition Time (0008,0032) and Content Time (0008,0033) must be updated to reflect the new start time if the first frame is not the same as the original. This is typically the case where the multi-frame object is a video and where the first frame is not included. Likewise, Image Trigger Delay(0018,1067) may need to be updated. ZZ.2.3 Time Interval vs. Frame Increment Vector The Frame Time (0018,1063) may need to be modified if frames in the new image are not a simple contiguous sequence from the original, and if they are irregular, then the Frame Time Vector (0018,1065) will need to be used in its place, with a corresponding change to the Frame Increment Pointer (0028,0009). This also needs careful consideration if non-consecutive frames are requested from an image with nonlinearly spaced frames. ZZ.2.4 MPEG-2 Identifying the location of the requested frames within an MPEG-2 data stream is non-trivial, but if achieved, then little else other than changes to the starting times are likely to be required for MPEG-2 encoded data, as the use-cases for such encoded data (e.g. endoscopy) are unlikely to include explicit frame related data. See the note below however for comments on single-frame results. An application holding data in MPEG-2 format is unlikely to be able to create a range with a frame increment of greater than one (a calculated frame list with a 3 rd value greater than one), and if such a request is made, it might return a status of AA02 : Unable to extract Frames. 1170 The approximation feature of the Time Range form of request is especially suitable for data held in MPEG- 2 form, as it allows the application to find the nearest surrounding key frames, which greatly simplifies editing and improves quality.

Page 42 1175 ZZ.2.5 JPEG 2000 Part 2 Multi-Component Transform Similar issues exist as for MPEG-2 data and similar solutions apply. ZZ.2.6 Functional Groups for enhanced CT, MR etc. It is very important that functional groups for enhanced image objects are properly re-created to reflect the reduced set of frames, as they include important clinical information. The requirement in the standard that the resulting object be a valid SOP instance does make such re-creations mandatory. 1180 1185 1190 ZZ.2.7 Nuclear Medicine Images Images of the Nuclear Medicine SOP class are described by the Frame Increment Pointer (0028,0009) which in turn references a number of different Vectors as defined in Table C.8-7 in PS3.3. Like the Functional Groups above, these Vectors are required to contain one value for each frame in the Image, and so their contents must be modified to match the list of frames extracted, ensuring that the values retained are those corresponding to the extracted frames. ZZ.2.8 A Single-Frame Multi-Frame Image The requirement that the newly created image object generated in response to a Frame level retrieve request must be the same as the SOP class will frequently result in the need to create a single frame instance of an object that is more commonly a multi-frame object, but this should not cause any problems with the IOD rules, as all such objects may quite legally have Number of Frames = 1. However, a single frame may well cause problems for a transfer syntax based on video such as those using MPEG-2, and therefore the SCU when negotiating a C-GET should consider this problem, and include one or more transfer syntaxes suitable for holding single or non-contiguous frames where such a retrieval request is being made. 1195 ZZ.3 FRAME NUMBERS Frame numbers are indexes, not identifiers for frames. In every object, the frame numbers always start at 1 and increment by 1, and therefore they will not be the same after extraction into a new SOP Instance. A SOP Instance may contain internal references to its own frames such as mask frames. These may need to be corrected. 1200 1205 ZZ.4 CONSISTENCY There is no requirement in the Frame Level Retrieve Service for the SCP to cache or otherwise retain any of the information it uses to create the new SOP Instance, and therefore, an SCU submitting multiple requests for the same information cannot expect to receive the same object with the same Instance and Series UIDs each time. However, an SCP may choose to cache such instances, and if returning an instance identical to one previously created, then the same Instance and Series UIDs may be used. The newly created object is however guaranteed to be a valid SOP instance and an SCU may therefore choose to send such an instance to an SCP using C-STORE, in which case it should be handled exactly as any other Composite Instance of that SOP class. ZZ.5 TIME SYNCHRONIZATION 1210 The time base for the new composite instance should be the same as for the source image and should use the same time synchronization frame of reference. This allows the object to retain synchronization to any simultaneously acquired waveform data

Page 43 ZZ.6 AUDIO 1215 Where the original object is MPEG-2 with interleaved audio data in the MPEG-2 data stream, and where the retrieved object is also MPEG-2 encoded, then audio could normally be preserved and maintain synchronization, but in other cases, the audio may be lost. ZZ.7 PRIVATE ATTRIBUTES 1220 As with all modifications to existing SOP instances, an application should remove any data that it cannot guarantee to make consistent with the modifications it is making. Therefore, an application creating new images from multi-frame images should remove any private attributes about which it lacks sufficient information to allow safe and consistent modification. This behavior should be documented in the conformance statement.